Commencement Matters

Emergency Departments Services

I welcome the Minister of State

I welcome the Minister of State. The emergency department at University Hospital Limerick is the busiest in the country. By the end of the year approximately 64,000 patients will have presented in the department. Since 2014, the number of people presenting has gone from approximately 55,000 to the expected approximately 64,000 this calendar year. One can compare this with Cork University Hospital, which has seen slightly fewer people presenting this current year, with the figure of approximately 60,000. Cork University Hospital has 800 beds, which is double the number of beds in University Hospital Limerick, which has 400.

Reconfiguration occurred in 2009, with the full-time emergency departments at Ennis, Nenagh and St. John's Hospital closing, meaning 18 beds were eliminated, as they had six beds apiece. All patients were then put into University Hospital Limerick, which had only another 17 bays in the emergency department. There was a loss of 50 beds at Ennis, Nenagh and St. John's Hospital as well. There is an urgent need for 96 acute beds to be provided at University Hospital Limerick as a result. This proposal has been submitted and it is in the Health Service Executive, HSE, national capital plan. I am asking for it to be fast-tracked and that the Minister for Health, Deputy Simon Harris, allow seed money to be provided for the HSE national estates to allow design work to get under way to build facilities for these 96 urgently needed acute beds.

We have a new state-of-the-art emergency department which will be opened in May 2017, but that is only one piece of the jigsaw. The other piece is the building of the facilities for the 96 acute beds that are urgently required. They can be fast-tracked, even structurally, on the basis that we currently have a dialysis unit that has been operational since last Monday. It is in a single-storey building and beside it there is a critical care block, which is a four-storey building with the new emergency department on the ground floor and critical care units above it. We can build the facilities for the 96 emergency beds above the dialysis unit, making it a four-storey building, with 24 beds per floor.

I ask the Minister to facilitate two actions. The first is that seed money could be provided to University Hospital Limerick and the HSE national estates to allow design work to get under way for the 96 acute beds that are urgently required. When the capital review occurs in 2017, I ask that this project to provide the 96 beds be funded. More immediately, I would like an update on the winter plans in place to cater for the emergency departments. Many people in Limerick have contacted me as the scenes in the emergency department are chaotic. The Minister has seen this and the department in Limerick is continuously under pressure. It is not fit for purpose, but until the new department opens in May 2017, we need emergency measures to be put in place to ensure we can deal with the deviation.

The second action relates to progressing the facilities at which the 96 acute beds will be provided. That is a two-stage process. The first is to give the seed money to allow the design work to get under way. The second is for it to be funded and included in the mid-term capital review plan for 2017. The project will cost €25 million. The emergency department at University Hospital Limerick has more patients going through it than any other hospital in the country but it only has 400 beds. The hospital in Cork - literally down the road from University Hospital Limerick - has slightly fewer admissions, approximately 60,000. We have approximately 64,000 and yet the hospital in Cork has double the number of beds, 800. We need equity for University Hospital Limerick.

The Senator's case is well made

I thank Senator Kieran O'Donnell for raising this important and timely question. The Minister for Health, Deputy Simon Harris, has asked me to convey his apologies to the Senator because he cannot be here. He has a prior engagement to which he is committed today. If he could have come back for this, he would have done so.

I welcome the opportunity to address the House on this matter. The emergency department at University Hospital Limerick is one of the busiest in the country with over 60,000 attendances annually.

It is the busiest.

The numbers presenting continue to increase year on year, with figures for October showing an increase in emergency department attendance of 6.1% in comparison with the same period last year. This amounts to 3,063 more patients.

The Deputy will be aware that a new emergency department is being fitted out at University Hospital Limerick and will open next year. The new facility will triple the size of the current emergency department and will improve the experiences for those attending immeasurably, particularly in terms of comfort, privacy and dignity.

On 9 September, the HSE published the winter initiative plan 2016-17. The plan provides €40 million of additional funding for winter preparedness and to help to alleviate the pressures on our emergency departments during this time. As part of this initiative, University Hospital Limerick has been identified as one of the nine focus sites experiencing the greatest challenge in terms of emergency department pressures. I know that Senator O'Donnell is well aware of this. Consequently, these sites need specific support measures to enable them to respond more effectively to expected surges in demand for emergency care during the busy winter period.

The winter plan for the University of Limerick hospital group identifies the key actions needed to address the anticipated surge in activity during the winter period. This includes measures around avoiding hospital, improved patient flow, timely access and discharge. Actions will be taken to increase early discharges, address delayed discharges, fast-track triage for patients over 75 years of age and improve access to inpatient MRI capacity. In early November, the operational hours of the medical assessment unit at University Hospital Limerick was extended by three hours per day and is now exclusively allocated to patients presenting to the emergency department. This will facilitate the immediate assessment, diagnosis and treatment of patients presenting with medical conditions such as chest infections, chronic obstructive pulmonary disease, pneumonia, urinary tract infections, fainting episodes, clots in the leg, anaemia or non-acute cardiac problems.

The University of Limerick hospital group is also working to maximise the use of the model 2 hospitals in the region - in other words, the hospitals in Ennis, Nenagh and St. John's Hospital - to free up beds in University Hospital Limerick. The group aims to ensure the safety of patients and staff, as well as to minimise absenteeism and agency costs through staff vaccination for the flu virus.

The winter initiative has allowed for the provision of 50 additional home-care packages per week to ten specific hospital sites, including University Hospital Limerick, which will be receiving an additional six home-care packages per week until the end of February 2017. University Hospital Limerick will also benefit from measures in the winter initiative that are available to all hospitals, including an additional €10 million for home-help and home-care packages, the increased availability of aids and appliances and increases in availability of transition care beds.

An bhfuil tú sásta? Is the Senator happy?

The Senator may comment briefly. We have gone two minutes over time.

I thank the Minister of State for coming back on the winter initiative. No one should have to endure what patients and staff have to endure at the accident and emergency department in Limerick. The Minister for Health, Deputy Simon Harris, has been there. The new accident and emergency department will be on stream in May 2017. I hope that the beds recently closed at St. John's Hospital will be reopened as quickly as possible in order to alleviate pressure.

I will be writing to the Minister for Health and the chief executive of the HSE, Tony O'Brien. I will urge them to fast-track the seed money to allow the design work to be done for the facilities relating to the 96 acute beds, which are critical for the region. We cannot have a situation whereby we have fewer than half of the beds that Cork University Hospital has while having a greater number of accident and emergency admissions. In fact, we have the largest number in the country.

I will convey the Senator's two points on the seed money and the capital review to the Minister

Maternity Services

I thank the Minister of State for coming to the House. I fully understand the Minister is not available. I wish to raise the report on maternity services at Portlaoise. The report includes a recommendation that the Institute of Obstetricians and Gynaecologists made in its report on the future of maternity and gynaecological services in Ireland. The institute recommended, in December 2006, that clinical maternity networks should be established in Ireland. It also recommended that the maternity department at Portlaoise hospital be linked with the Coombe Women and Infants University Hospital in Dublin. This recommendation to establish clinical maternity networks was not progressed at national level. Some eight years later, in 2014, and in light of the range of adverse incidents highlighted earlier in the report, the report of the chief medical officer repeated the recommendation.

My concern this morning relates to the Portlaoise report. The report recommends that each of 19 maternity units throughout the country should have a director of midwifery. My understanding is that eight of the 19 units still have not appointed such a director. Part of the problem, as I understand it, is that the criteria for those who qualify for the job have been set so high that we cannot attract suitable candidates, especially in respect of the smaller units.

I raised this matter at the Oireachtas Joint Committee on Health four or five weeks ago. Some alterations have been made in the criteria. I still do not believe that we will be able to fill the eight vacant positions, despite the new criteria. We seem to be going on the line that a candidate must be at clinical nurse manager 3 level for a number of years before she can go forward for this job. There are staff who have maternity experience but who may have been working in a managerial capacity in other areas within hospitals and dealing with patients on a daily basis. These people are now excluded from applying for the jobs to which I refer. I am suggesting we must be practical, especially regarding the criteria we set out for the smaller units. A recommendation was made in 2006. I want to avoid a repeat of the situation where action had still not been taken eight years after that recommendation was made. We found ourselves in an unmerciful mess in the context of trying to sort out a major difficulty with a hospital. I do not want another report to be put on a shelf or to have to come back to the Minister 12 months from now only to find out that the positions are still vacant. That is the context in which I am raising this issue.

I thank the Senator for giving me the opportunity to address the vital issue of the implementation of the report by the Health Information and Quality Authority, HIQA, into the services being provided at the Midland Regional Hospital, Portlaoise. As the Senator will be aware, on Monday, HIQA published a review of the progress that has been made at the hospital in implementing the various recommendations made following the its investigation in 2015. This report was conducted following a request from the Department of Health. The Department has been overseeing the implementation of the recommendations in the original report to examine the progress that has been made at Midland Regional Hospital, Portlaoise. I very much welcome this report, which has found that additional funding and staff have been provided for the hospital and that significant progress has been made in respect of governance, patient safety and quality.

I acknowledge the reason we have travelled this far. It is thanks to the bravery of the families who spoke out in the midst of their grief. I have met and spoken to some of these people. In particular, I commend the maternity services. The report has described the services as providing care in a much safer and sustainable manner.

Portlaoise maternity services are reporting monthly maternity patient safety statements and are participating in national data collections, including the Irish maternity indicator system. This has led to a confirmation by HIQA that the hospital’s maternity services are performing in line with nationally reported rates.

The extent of progress in patient safety measures demonstrates the commitment of the staff and the leadership team at Portlaoise hospital and the team at hospital group level. Both the Department of Health and the HSE are committed to securing and developing the role of Portlaoise hospital within the Dublin Midlands Hospital Group.

The HIQA report also identified immediate issues to be addressed in general hospital services. The HSE has been asked to address these immediate issues as a priority, and to ensure that the hospital is appropriately supported in that role by the other hospitals in the group to serve the patients of the midlands. Hospital funding has increased by 15% since 2012 and staffing levels have increased by 18%. Additional funding is also to be provided to facilitate the opening of the new medical assessment unit in the hospital in 2017.

The hospital group has produced a draft action plan for the hospital which takes account of the need to develop services in the context of developing the model of service provision for the entire group. The HSE has submitted the draft plan to the Department where it will be reviewed in detail.

With regard to the question the Senator asked concerning the appointment of directors of midwifery, five such positions were in place at the time the recommendation was made and, to date, seven additional candidates have been selected. A series of recruitment competitions are continuing to appoint people to the remaining seven positions to ensure all our maternity hospitals have senior midwifery decision makers.

I am happy to share the Senator's concerns about qualification standards with the Minister.

I thank the Minister of State for her reply. She said there are seven vacancies. The health committee was informed that there were only three or four vacancies. There should be clarity and transparency about this. The hospitals that have not filled these vacancies should be clearly identified along with the timescale for filling them. When will the recommendations be fully accepted? I do not want a scenario where we are trying to fill these positions eight years later with some only being filled on a temporary basis in order that the same problem that arose in Portlaoise does not arise again.

The report highlights the variation in the delivery rate in Portlaoise hospital between 2007 and 2013 but it did not refer to the rate between 2000 and 2007 when it increased by more than 100%. The number of deliveries increased from more than 1,000 to more than 2,000. No HSE manager was held responsible for the failure to appoint additional staff. No one is being held accountable now for the failure to fill these vacancies. There should be clear accountability and a clear timescale to fill them.

The information I have provided has been gleaned from the HSE and I will get clarification on the outstanding vacant positions for the Senator.

Public Procurement Contracts Social Clauses

I welcome the Minister of State. Public procurement accounts for 18% of gross domestic product in Europe, and the State spends €8.5 billion every year on goods and services. There is a growing interest in finding ways for this expenditure to be used to deliver wider social, environmental and economic benefits.

In March 2014, the then Minister for Public Expenditure and Reform, Deputy Brendan Howlin, stated:

The use of social clauses in public procurement is limited to instances where they are targeted at factoring into the procurement process consideration of social issues such as employment opportunities, equal opportunities and social inclusion. In order to be compatible with EU law, they must be made known to all interested parties and must not restrict participation by contractors from other member states.

He then went on to confirm that a pilot project had been initiated under the devolved schools building programme.

Social clauses are provided for in European directives, regulation and case law. They can ensure local hiring clauses and apprenticeship clauses are stitched into public procurement contracts. The clauses originated in national law across a number of European states. They fell foul of European competition law, but then a special directive was passed to allow for them with appropriate caveats attached. The reason these social clauses are so important is that without them there is an increasing tendency for contractors to bring their own mobile workforce with them, which means that when public contracts are issued, there is no local dividend in terms of jobs and training for the local community. The contracts operate very successfully in many EU states. I refer to the social clauses in operation in the North, which were introduced by my party. For every €1 million of contract value, the successful bidder has to hire a local unemployed qualified person and a local apprentice. This is working well and the Peace Bridge in Derry is one example of a major project that produced a very good local dividend in employment and training.

Unfortunately, local authorities in Ireland are telling councillors that they cannot include social clauses in procurement contracts as they are awaiting the issuing of guidelines from the Office of Government Procurement, OGP, with regard to the operation of social clauses. A year ago, I understand former Labour Deputy, Derek Nolan, asked the OGP about this topic and was told that it was finalising guidelines and that local authorities could expect to see them the following spring. The difficult is a number of local authorities are still telling us that they have not received the guidelines. There are hard pressed communities up and down the country, which are major unemployment blackspots. Implementation of these clauses could make a major contribution to providing work and opportunities for training. We should not have to wait this long. I hope the Minister of State can confirm that these guidelines have issued, or a date on which they will.

Public procurement is governed by the EU treaty, EU directives, regulations and national guidelines. They set down rules whereby contracting authorities must award contracts under procedures designed to achieve value for public money in an open, transparent and non-discriminatory competitive process. The rules recognise that public procurement can be used to promote wider economic, social and environmental issues and further legal clarity in respect of the use of social clauses has been provided in the new EU directives on public procurement, which were transposed into Irish law last May. The general position is that social criteria can be included at various stages of the procurement process from business case, through to specification, selection and award stages through to the contract performance stage provided that they are linked to the subject matter of the contract and are contract specific. In respect to the latter, it is important that contracting authorities have in place procedures to effectively monitor compliance with the conditions of the social clause.

For example, social clauses have been successfully piloted in the devolved schools building programme where a clause was included in the public works contracts which required that 10% of the aggregate time worked on site to have been undertaken by individuals who have been registered on a national unemployment register within the European Union for a continuous period of at least 12 months immediately prior to their employment on the project, and 2.5% of the aggregate time worked on site to have been undertaken by individuals who are employed under a registered scheme of apprenticeship or other similar national, accredited training or educational work placement arrangement. The Department of Social Protection, through its Intreo offices, has provided support to the contracting authority in monitoring compliance with the conditions of these social clauses and also to contractors in meeting their obligations under the contract by providing suitable candidates to match the skills requirements from long-term unemployed construction workers. Approximately 48 long-term unemployed persons have been hired across the 15 sites in question out of a total workforce of approximately 440. The appropriateness of social clauses in procurement projects will vary from contract to contract.

Experience in other jurisdictions suggest they are most successfully employed in large scale works contracts as opposed to contracts for goods and services. There are also other important considerations. Account needs to be taken to ensure that value for money is not adversely affected, additional costs are not placed on domestic suppliers relative to other potential suppliers, contracts are of a minimum scale to absorb the increased administrative requirements, and the targeted benefit is capable of being measured and monitored during the execution of the contract. Where recruitment and training clauses are used the contracting authority needs to have a good understanding of supply side issues such as for example in the area of training supports. It is important that contracting authorities are not compelled to use social clauses on every contract, particularly where their deployment may disproportionately impact on SMEs bidding for public contracts. Notwithstanding these concerns, the Government sees merit in developing a social clauses framework.

The Office of Government Procurement is developing practical guidance aimed at providing assistance to contracting authorities in the use of social clauses across the public sector. These will reflect the new EU procurement directives. In the interim period, there is no impediment preventing contracting authorities in the local authority area from inserting social clauses in their contracts. There is sufficient information available from their use in the pilot projects already referred to and other PPP projects to allow local authorities to devise suitable clauses for inclusion in works and capital projects if they so wish.

Overall, it is important that social clauses be implemented in a targeted manner as opposed to any blanket or across-the-board approach, which may cause more difficulties than it solves.

I thank the Minister of State for his reply. It is helpful, in that he states there is sufficient information available for local authorities. The problem in practical terms is that local authorities are using the lack of guidelines as an excuse not to engage. I have concrete examples, Galway County Council being one, as it states it does not have the guidelines and so cannot include the social clause.

The other big problem, which I mentioned in my initial remarks, is that 12 months ago the Office of Government Procurement told us it was preparing guidelines. Is this another example of this Government not being able to do or deliver anything because the Office of Government Procurement is still saying it is working on the guidelines? It does not take 12 months to produce guidelines for social clauses. The Minister of State's example shows that these clauses can have a significant impact on the unemployed and apprenticeships and I can see no excuse for the OGP to be still working on guidelines. Will the Minister of State give a commitment on the date the guidelines will issue?

There is nothing standing in the way of a local authority introducing social clauses into its procurement contracts. Local authorities procure a significant amount of goods, services and capital works and have been doing so for decades. They have the resources where they want to or should introduce a social clause based on the information already in the public domain and on what the Office of Government Procurement has put into the public domain and the work it has already done. While it is important that the Office of Government Procurement issue guidelines, and it will shortly, that should not be used as an excuse for local authorities to delay introducing social clauses.

I am talking about 12 months ago. Can the Minister of State give me any specific information?

I cannot now but centralising the procurement function in government is a relatively new enterprise undertaken by the last Government. It is doing incredible work in finding value for money, making sure we are not just chasing the bottom line when we procure but that we take into account other factors in procurement contracts and in rolling out pilot projects under social clauses. As the Senator is probably aware, the Office of Government Procurement and I are making a public presentation for Senators and Deputies tomorrow to go through and discuss several issues. If we can give a firm commitment on a date tomorrow we will do that then.

Sitting suspended at 11.05 a.m. and resumed at 11.30 a.m.